Device for use in eye surgery

ABSTRACT

The present invention relates to a method of manufacturing an intraocular lens inside a capsular bag ( 28;73 ) after that the natural lens has been removed and to a sealing device ( 21;41;61;71 ) comprising a plug part ( 23;43;63;77 ) adapted to seal a rhexis ( 30;75 ) in a capsular bag ( 28;73 ) and thus preventing displacement through the rhexis ( 30;75 ) of a lens-forming liquid material injected through the rhexis ( 30;75 ) and adapted to replace the natural lens and form an intraocular lens implant.  
     According to the invention said plug part ( 23;43;63;77 ) has a slightly larger area than the capsulorhexis ( 30;75 ) and is made of a deformable polymer. Also according to the invention the sealing device ( 21;41;61;71 ) comprises an adjusting means ( 25;45;65 ), connected to the plug part ( 23;43;63;77 ), said adjusting means ( 25;45;65 ) having the function of positioning said plug part ( 23;43;63;77 ) to a desired location.

FIELD OF THE INVENTION

[0001] The present invention relates to a sealing device comprising aplug part adapted to seal a capsulorhexis of a capsular bag used insurgical processes involving insertion of lens-forming liquid to replacethe natural lens and forming an intraocular lens implant. It alsorelates to a method providing visual correction including manufacturingan intraocular lens inside a capsular bag after that the natural lenshas been removed.

BACKGROUND OF THE INVENTION

[0002] A technique for removing a catarcteous and/or presbyopic naturallens from the capsular bag of the eye and replacing it by a lens-formingliquid material injected directly into the capsular bag is underdevelopment. This is described in for example the patent applicationwith application number SE 0001934-9. The liquid material is a partiallypolymerized material, which can undergo a curing process in the eye andthereby form a solid lens implant. The lens implant acts as a substitutefor the natural lens and aims to substantially restore the features ofthe natural lens of the young eye. Materials and methods suitable forinjection and subsequent formation of an IOL (Intra Ocular Lens) aredisclosed in the patent applications PCT/EP99/07781, PCT/EP99/07780,PCT/EP99/01766 and SE 0001934-9. The defect natural lens matrix can beremoved by a conventional surgical method involving an ultrasound probe,such as a phacoemulsification method involving aspiration. In order tofacilitate the removal of the lens matrix and the refilling with lensforming liquid material, a capsulotomy i.e. a capsulorhexis is preparedin the anterior wall of the capsular bag. The capsulorhexis is preparedfrom a circular or essentially circular capsultomy in the capsular bagwall, typically with a diameter of from about 0.5 to about 2.5 mm. Aninjection syringe needle is inserted through an incision in the eye andthrough the capsulorhexis into the capsular bag so the lens-formingliquid material can be injected into the capsular bag.

[0003] It has been identified as a problem in capsular bag fillingprocesses that during the injection and before the final lens is formedliquid material can leak through the capsulorhexis. For this purpose aplug is proposed in the Japanese patent specification JP97-308946. Thisplug is adapted to be attached to the injection syringe needle andinserted to the eye and positioned in the right position in the rhexiswhen the syringe needle is inserted. A problem with this plug is that itis clamped and/or glued in the rhexis. Since the plug is relativelylarge and adapted to stay in the rhexis permanent optical problems couldarise. Furthermore, it needs a relatively large opening in the eye to beimplanted. The plug comprises also a filling tube, which has to be cutoff after filling. The tube could cause a leak. The size of the plug mayalso influence the free movement of the capsule that is needed for aneven deformation of the capsule during accommodation. In theInternational Patent Application published as WO 00/49976 (University ofMiami), a more simple plug construction is suggested that attempts toact as a valve during the surgical process. Also this plug suffers fromthe drawback that it permanently locates parts of its structure outsidethe capsular bag after finalizing the surgery. The curved flexiblemember is permanently protruding from the capsular bag through its hublike attachment point to the flexible discoid flap-valve member.Consequently, the protruding parts may risk to compromise surroundingdelicate eye tissues, including the iris, while they also riskgenerating unwanted optical side effects. It is therefore obvious thatit is need for improvements in plug parts or sealing means for acapsulorhexis that has been introduced in a capsular filling process.

DESCRIPTION OF THE INVENTION

[0004] It is an object of the invention to provide a sealing device fora capsulorhexis of the capsular bag of the eye that effectively preventsa liquid inserted into the capsular bag to leak out through thecapsulorhexis.

[0005] It is also an object of the present invention to provide asealing device for a capsulorhexis that leaves no permanent partsoutside the capsular bag after the lens implantation process isfinalized.

[0006] Another object is to provide a sealing device having means bywhich its location can be controlled after its insertion throughout thecapsule filling process and lens forming process.

[0007] Still a further object of the invention is to provide a sealingdevice for the capsular bag that can contribute to compensate forrefractive errors and/or wavefront aberrations of the optical parts ofthe eye.

[0008] These objects are obtained with a sealing device having a plugpart made of a deformable polymer that is capable of admitting theentrance of an injection device for injecting a lens-forming liquidmaterial through the capsulorhexis, while having slightly larger areathan the capsulorhexis, so as to obtain a sealing effect from beingpressed in a tight sealing position with the inner capsular bag from thepressure exerted by the injected liquid material. The sealing devicefurther comprises an anteriorly protruding removable adjusting meansconnected to the plug part. By the adjustment means, the plug part canbe displaced exactly to the desired location by surgeon. It is animportant characteristic of the presently invented sealing device thatit is free from any features protruding out from the capsular bagsubsequent to the surgical process. This is due to that its adjustmentmeans is readily removable through surgical incision of the eye when thesurgeon so decides. The highly simplified construction of the sealingdevice that leaves no permanent parts outside capsular bag protrudingout in posterior chamber of the eye resides from the finding that thefluid lens forming material is capable of exerting a sufficient pressureon the deformable sealing device so it together with the capsular bagwall can act sufficiently sealing without the need of additionalsecuring means.

[0009] Preferably, said plug part is essentially disc-shaped andsuitably said plug part is adapted to be placed at the inside of thecapsular bag, covering the whole capsulorhexis. It is suitable that theplug part has a somewhat larger diameter than the capsulorhexis toenable a safe sealing effect. A suitable plug diameter is accordingly inthe range of about 0.5 to about 2.5 mm. However, in certain embodimentsdescribed below the plug part can have a considerably larger extension.The plug part of the sealing device is adapted to permanently remain inthe eye, but can alternatively, be removed after the lens formingprocess in the capsular bag is completed and the lens forming materialis satisfyingly cured. In such case, the adjustment means are notremoved, but employed to carefully loose the plug part and transfer itout of the eye.

[0010] The plug part is made of a suitable soft, flexible, biocompatiblematerial that is sufficiently thin to follow the accommodation movementsof the capsular bag. Normally that means that the plug part will have athickness in the range of about 5 to 250 micrometers. In order to avoidany problems of material incompatibility, or eventually any optical sideeffects, it is preferable that the plug part is made of a similarmaterial to the lens forming material. Preferably the plug part is madefrom a silicon material to comply with an injectable lens formingsilicon material. For the condition that the capsulorhexis is placed inthe visual field, it is greatly preferable that the plug part is made ofa material having essentially the same refractive index as the materialinserted in the capsular bag. This is important especially if the plugpart is to be left in the capsular bag after that the lens-formingprocess is completed. Hereby, the sealing device does not affect thevisual quality. Suitable silicone materials can be found among theterpolymers mentioned in PCT/EP99/07781 and PCT/EP99/07780, or the highrefractive index silicones, for example, disclosed in U.S. Pat. Nos.5,236,970 and 5,444,106, optionally without UV absorbers and otheradditives regarded unsuitable for the present technical application.Also various medical grades of conventional polydimethylsiloxanes (PDMS)are suitable within certain embodiments of the invention. The plug partcan be prepared with conventional molding processes for silicones, whichtogether with other suitable silicones than the aforementioned are wellknown to persons skilled in this technology.

[0011] The adjusting means typically is one or several thin flexiblewire(s) that is non-permanently attached to the plug part. In a suitableembodiment, the thin wire penetrates the plug part from the anterior tothe posterior side and then penetrates the plug part from the posteriorto the anterior side. The distance between the two penetrating positionsand their locations on the plug part are selected so that it can becomfortably manipulated, either with a microforceps, or with othersuitable means, also from outside of the eye. It is to be understoodthat the thin wire can be of such a length that it protrudes out of theeye through the corneoscleral incision. The wire is preferably made ofless flexible material than the material of the plug part and thecapsular bag and is attached to the plug part in a manner that is easilycan be removed when the lens forming material is introduced, or whenthen lens forming process is finalized. Typically suitable materials forthe wire are different brands of nylons that are well known in surgicalprocesses and not discussed in further detail.

[0012] In one aspect of the invention, the plug part of the sealingdevice is provided with a contacting means that establishes an improvedcontact between the anterior surface of the plug part and the inner(posterior) wall of the capsular bag, so to prevent or hinder anydisplacements of the plug part from forces exerted on the capsular bagwall during the accommodation process. Further, substantial problems toobtain a correct accommodation process may arise if the capsulorhexis tobe sealed has a large extension, such as exceeding several millimeters.In order to ensure correct accommodation processes, the forces exertedon the capsular bag needs to be transmitted correctly without any deadzones incapable of participating in the process. When a very soft lensmaterial is employed which has sufficiently low elasticity modulus as toform accommodating lens, this type of dead zones and/or large plug partdisplacements during accommodation, may eventually cause that lensmaterial does not correctly participate in the accommodation, or atworst will bulge out anteriorly with uncontrollable consequences. Tocomply with any such unwanted effects, the plug part preferably isprovided with contact means to improve the contact between the plug partand the capsular bag wall. Suitable contact means can be accomplished byproviding plug part with an anterior surface that, at least partially,admits an enhanced friction to the inner wall of the capsular bag. As anexample, this can be accomplished with the provision of a peripheralring-shaped roughened anterior surface adapted to improve contact theinner wall of the capsular bag. Hereby, the contact between the sealingdevice and the inner wall of the capsular bag is improved. Frictionenhancing processes and roughening processes are well known to siliconexperts and are not elaborated on herein in any detail. Suitably, thewhole area designated to contact the capsular bag inner wall is modifiedor treated accordingly which means that typically that about 5 to 50% ofthe total surface is modified or treated.

[0013] In another aspect of the invention, the plug part of the sealingdevice has an anteriorly extending ring in the middle with a diameterfitting into the capsulorhexis from below. The ring is adapted tostabilize the correct position of the sealing device.

[0014] According to a special embodiment, the plug part has a cutadmitting passage of the lens-forming material. Hereby, the sealingdevice can be more easily retained in its position during the injectionof lens forming material. Suitably, the cut is provided with anoverlapping part adapted to seal the cut when the injection iscompleted, in order to prevent from undesired leakage of injectedlens-forming material through the cut.

[0015] The inventive sealing device can suitably be positioned in acapsulorhexis of about 1 mm in diameter positioned off the optical axisof the eye, i.e. outside the normal visual field. Alternatively, thecapsulorhexis includes the optical axis. In such case, it is ofimportance that the plug part is perfectly optically clear and that itdoes not contribute to any optical side effects. Preferably, the plugpart is then made of a material that has the same or essentially thesame refractive index as the lens forming material.

[0016] In another embodiment of the invention, the sealing device isdesigned to have specific predetermined optical characteristics and tobe used in the visual field of eye. The sealing device will then havesuch an extension that it extends over the whole, or substantially thewhole, visual field of the eye and can individually tailored for apatient to correct for optical deficiencies, including refractive errorsor aberrations typically arriving from individual irregularities of thecorneal surfaces. In a surgical correction process, aiming to make useof the optical characteristics of the sealing device, a larger part ofthe anterior capsular bag can be surgically excised, such as about 2 to6 mm of the capsular bag surrounding the optical axis. A sealing devicehaving suitable extension to comply with an accordingly excised capsularbag can the be employed in a capsular bag lens filling process thatadmits visual correction of optical errors also from other parts of theeye, such as the corneal surfaces. The plug part of the sealing devicecan then be provided with a refractive power or with optical surfacesthat can correct for aberrations, such as astigmatism and/or sphericalaberration. Typically such a sealing device having lens power can bemade in material having different refractive index than the injectablelens forming material and be provided with at least one surfacedeviating from perfect sphericity, i.e. being aspheric to reduce oreliminate aberrations.

[0017] The present invention also relates to a method of performingvisual correction that involves the manufacturing of an intraocular lensinside the capsular bag of the eye. The method comprises the steps of:

[0018] inserting a sealing device in a capsulorhexis, said plug partbeing adapted to cover the capsulorhexis from the inside of the capsularbag;

[0019] adjusting the location of said sealing device with an adjustingmeans operable from the outside of the capsular bag;

[0020] delivering a lens-forming material through the capsulorhexis intothe capsular bag by using a delivering means and by displacing and/ordeforming the plug part to admit passage for the material;

[0021] removing the delivering means out from the eye, whereby the plugpart retains its sealing position, thereby preventing displacement ofthe lens-forming liquid material out from the capsular bag.

[0022] In one embodiment, the method comprises removing the sealingdevice through the capsulorhexis when the lens-forming process iscompleted. Otherwise, only the adjusting means is removed when the plugpart has been positioned to seal capsulorhexis by the insertedlens-forming material in the capsular bag. Suitably the method comprisesdeforming the plug part so as to obtain a shape insertable through thecapsulorhexis. Preferably the method comprises controlling the positionof said plug part by means of the adjusting means.

[0023] In one embodiment the method comprises inserting the lens-formingmaterial to the capsular bag through a cut in the plug part and throughthe capsulorhexis.

[0024] The method can also comprise a step where an agent thatcounteracts secondary cataract is introduced in the capsular bag beforeintroducing the lens forming material. Such agents typically aretypically introduced with an injection syringe that can displace ordeform the plug part sufficiently to insert a for injection needle inthe capsular bag. The plug part provides a sufficiently sealedenvironment that the injected agent is prevented from coming in contactwith other ocular tissues than the inner wall of the capsular bag duringthe secondary cataract treatment. Suitable agents are cytotoxic orantiproliferative agents that counteracts growth of epithelial cellsthat can compromise the transparency of the postsurgical capsular bag.An example of such an agent is 5-fluorouracil, but numerous other agentsare conceivable to the skilled person. Alternatively an agent capable ofblocking epithelial cell adhesiveness would be a useful such as thecalcium channel blocker mibefradil.

[0025] In a special embodiment the method further comprises measuringthe error of refraction of the eye and designing the plug to furthercompensate for error of refraction. In this embodiment, the method alsocan comprise measuring one or several aberrations of the cornea by acorneal topographic method or with conducting a wavefront analysis ofthe aphakic eye during the surgical process, for example with aHartmann-Scahck sensor equipment, or the similar. The method can alsoinvolve estimations of the aberrations that will be generated in a wavefront arriving from the lens to be formed in the capsular bag.Preferably, the results from these optical measurements can be employedto design the surface of the plug to compensate for the aberration ofthe eye, or alternatively to select a sealing device having plug partthat will provide the best optical outcome for an individual, among aplurality of sealing devices in a kit with different refractive valuesand/or aberrations.

[0026] It is obvious that the present invention provides a highlyadvantageous sealing device for use in ophthalmic surgery that admits ahigh degree of versatility and readily can be adapted for numerousdifferent surgical conditions due to its simplified construction and itsadaptability to its ocular environment. The following part aims toexemplify some specific embodiments of sealing devices that aims to beillustrative, but not limiting for the scope of invention.

BRIEF DESCRIPTION OF THE DRAWINGS

[0027]FIG. 1a is a schematic view from above of a sealing deviceaccording to a first embodiment of the invention.

[0028]FIG. 1b is a side view of the sealing device in FIG. 1a insertedinto a capsular bag.

[0029]FIG. 2 is a view from above of a second embodiment of the sealingdevice according to the invention.

[0030]FIG. 3 is a view from above of a third embodiment of the sealingdevice according to the invention.

[0031]FIG. 4 is a side view of a sealing device according to theinvention inserted into a capsular bag.

DETAILED DESCRIPTION OF THE EMBODIMENTS

[0032]FIG. 1a is a schematic view from above of a sealing device 21according to a first embodiment of the invention. The sealing device 21comprises an essentially disc-shaped plug part 23 and an adjusting means25. The plug part 23 is made of a deformable polymer such as a siliconmaterial. In this embodiment the adjusting means 25 is a nylon threadattached at its middle to the center of the plug part 23. For example,the thread can pass through two holes in the plug part 23 leaving theadjusting means 25 with two thread ends 26 a and 26 b pointing out fromthe plug part 23 on the same side. This thread 25 could of course beattached to the plug part 23 in some other way and it can be made fromanother material than nylon. It is also possible to only attach one endof the thread to the plug part 23 leaving only one end pointing out fromthe plug part 23. The nylon thread used in this embodiment has asuitable stiffness so it enables manipulation of the plug part. Thematerial of the can have a refractive index compatible with the lensmaterial and it should follow the deformation of the capsular bag if thesealing means is adapted to be left in the rhexis.

[0033]FIG. 1b is a side view of the sealing device 21 shown in FIG. 1ainserted into a capsular bag 28. The plug part 23 of the sealing device21 is inserted inside the capsular bag and it is adapted to cover arhexis 30 in the capsular bag from below. The nylon threads 26 a, 26 bare extending anteriorly from the sealing device 21 and preferably theyare long enough to protrude out of the eye. Thus, the sealing device 21can be controlled and kept in the desired location from outside the eye.The sealing device 21 is adapted to be inserted into the eye before thelens-forming liquid material is injected and after that the natural lenshas been removed.

[0034] When the lens-forming material is injected, a delivering means,here an injection syringe is used. The injection syringe needle isinserted through the eye and through the capsulorhexis by sufficientlydisplacing and/or deforming the sealing device so the needle is admittedinto the capsular bag. After the injection the syringe needle is removedout from the capsular bag and the eye and the pressure exerted by thefluid lens-forming material provides the sealing device to retain itsoriginal position and shape in front of the rhexis thus preventing thelens-forming material to leak out. The lens-forming material can now becured into the final lens implant and the wire can be removed from theeye with for example a forceps. To be noted is that the injectionsyringe not actually needs to be inserted all the way into the capsularbag. It is enough to inject the lens-forming material outside the rhexisin a direction towards the rhexis. Then the material will force itselfthrough the sealing device and into the capsular bag. If a small amountof the material would be left in the anterior chamber of the eye it willeasily be flushed out by the rinsing liquid as used during the surgicalprocedure.

[0035] The liquid material can be a silicon material that will cure inambient body temperature or that will cure through another curingmechanism by means of photosensitizers activated by light of a selectedwavelength as further described in PCT/EP99/07781. When the lens-formingfluid has filled the capsular bag the sealing device 21 is pressedagainst the inner wall around the rhexis of the capsular bag by the lensimplant. If the sealing device 21 is adapted to be left in the capsularbag only the adjusting means 25 is removed. Otherwise, the whole sealingmeans 21 is removed. The plug part 23 could be deformed by an instrumentoperated from outside the eye such that it can be removed through therhexis. The position and the size of the rhexis could be the same asdescribed for the first embodiment but if the plug part is adapted to beleft in the rhexis the rhexis preferably is positioned so as to includethe optical axis. The rhexis is also preferably larger than one mm indiameter and thus the plug part also has to be larger than in the firstembodiment to cover the whole rhexis. In fact the plug part preferablycovers the whole path of light that is admitted by the pupil. In thecase where the plug part 23 is left in the eye the plug part 23 materialshould also have essentially the same refractive index as thelens-forming material. When the sealing device 1 is left in the rhexis 9the plug part 2 preferably is made of such a material and has suchdimensions that it follows the deformation of the capsular bag asdescribed above. The plug part 23 in this embodiment preferably can bedesigned to further correct for refractive error in the eye. It can alsobe designed to correct for aberration defects of the optical surfaces ofthe eye, such as spherical aberration. The necessary measurements of theaberrations of the eye and the designing of a surface needed to beprovided to the plug part 23 to compensate for the aberration aredisclosed in detail in the patent application SE 0001925-7 which isincorporated in this application by reference. It is also possible toexcise a larger part of the capsular bag wall than demonstrated in FIG.1b and thereby provide a larger opening of the capsular bag and use alarger sealing device that can extend over the whole visual field. Aconsiderable possibility to provide visual correction that iscomplementary to what is possible from the injected lens is therebyprovided.

[0036]FIG. 2 is a view from above of a sealing device 41 according to asecond embodiment of the invention. This second embodiment of thesealing device 41 principally follows the first embodiment of thesealing device. It comprises a plug part 43 and an adjusting means 45.The materials and the dimensions are the same and the use of the sealingdevice is also the same. The difference is that the plug part 43 isprovided with a roughened surface 47 on the part of the surfacecontacting the inner wall of the capsular bag. The purpose of thisroughened surface 47 is to keep the sealing device 41 in the desiredlocation covering the rhexis. The plug part 43 comprises also a cut 49along a radius of the disc-shaped plug part 43. The purpose of the cut49 is to make it easier for the injection syringe needle to come throughthe rhexis during the injection and to minimize the leakage of theinjected material through the rhexis during the injection. Preferablythe plug part 43 also is provided with an overlapping part 51 under thecut 49. The purpose of the overlapping part 51 is to prevent thematerial from leaking out through the cut 49 after the needle has beenremoved. As explained above it is not necessary to insert the injectionsyringe needle all the way through the rhexis to insert the lens-formingmaterial. However, the cut 49 also in this case simplifies theinjection.

[0037]FIG. 3 is a view from above of a sealing device 61 according to athird embodiment of the invention. Also this third embodiment of thesealing device 61 principally follows the first embodiment of thesealing device. It comprises a plug part 63 and an adjusting means 65.The materials and the dimensions are the same and the use of the sealingdevice is also the same. The difference is that the plug part 63comprises on the surface from which the adjusting means 65 protrudes ananteriorly protruding ring 67 with a slightly smaller diameter than thediameter of the rhexis. This ring 67 is adapted to fit into the rhexiswhen the plug part 63 has been located in the capsular bag so as to keepthe sealing device 61 in the correct position sealing the rhexis fromthe inside of the capsular bag.

[0038]FIG. 4 is a side view of a sealing device 71 of any of the abovementioned kind inserted into a capsular bag 73 through a rhexis 75. Therhexis 75 is in this case located off the optical axis A of the eye. Therhexis 75 has here a diameter of only about 1 mm and a plug part 77 ofthe sealing device 71 has thus a slightly larger diameter. The sealingdevice 71 could in this case either be left in the capsular bag 73 sinceit is located off the optical axis and not will disturb the vision or beremoved from the eye. The removing of the sealing device 71 is easier inthis case when the sealing device is smaller.

[0039] Of course the different described features in all theseembodiments can be combined in all possible ways.

1. A sealing device (21;41;61;71) for use in ophthalmic surgery toreplace a catarcteous and/or presbyopic natural lens, comprising aflexible plug part (23;43;63;77) adapted to seal a capsulorhexis (30;75)of a capsular bag (28;73), while admitting the entrance of injectiondevice for injecting a lens-forming liquid material through thecapsulorhexis (30;75), said plug part (23;43;63;77) having slightlylarger area than the capsulorhexis (30;75) and is made of a deformablepolymer, wherein said sealing device (1;21;41;61;71) further comprisesan anteriorly protruding removable adjusting means (25;45;65), connectedto the plug part (23;43;63;77) capable of positioning said plug part(23;43;63;77) to a desired location.
 2. A sealing device according toclaim 1 characterized in that it is free from any parts protruding outfrom the capsular bag subsequent to the surgical process.
 3. A sealingdevice according to claim 1, wherein said plug part (23;43;63;77) isessentially disc-shaped.
 4. A sealing device according to any one of thepreceding claims, wherein said plug part (23;43;63;77) is adapted to beplaced at the inside of the capsular bag (28;73), covering the wholecapsulorhexis (30;75).
 5. A sealing device according to any one of thepreceding claims, wherein said plug part (32;43;63;77) being made of asuitable soft material and being enough thin for following theaccommodation movements of the capsular bag.
 6. A sealing deviceaccording to any one of the preceding claims, wherein said plug part(23;43;63;77) is made of a silicon material.
 7. A sealing deviceaccording to any one of the preceding claims, wherein said plug part(23;43;63) is made of a material having essentially the same refractiveindex as the material inserted in the capsular bag (7;28).
 8. A sealingdevice according to claim 1, wherein the plug part is provided withcontacting means to capsular bag so as to ensure that a correctaccommodating process is established.
 9. A sealing device according toclaim 8, wherein said contact means consists of a friction enhanced partof the anterior surface of the posterior plug.
 10. A sealing deviceaccording to claim 9, having a roughened surface (47) on at least thesurface contacting the inner wall of the capsular bag (7;28).
 11. Asealing device according to claim 1, having an anteriorly extending ring(67) in the middle with a diameter fitting into the rhexis from below,the ring (67) being adapted to stabilize the position of the sealingdevice (61) in the rhexis.
 12. A sealing device according to claim 1,wherein the removable adjusting means (25;45;65) is at least oneflexible thread (25;45) attached to the plug part (23;43;63).
 13. Asealing device according to claim 12, wherein the at least one thread(25;45;65) protrudes in an anterior direction from the plug part(23;43;63).
 14. A sealing device according to claim 13, wherein said atleast one thread (25;45;65) is of such a length that it protrudes tooutside the eye and can be manipulated from outside the eye.
 15. Asealing device according to any one of the preceding claims, wherein theplug part (43) has a cut (49) admitting passage of the lens-formingmaterial.
 16. A sealing device according to claim 15, wherein the cut(49) is provided with an overlapping part (51) adapted to seal the cut(49) when the injection is completed.
 17. A sealing device according toany one of the preceding claims, being adapted to be positioned in arhexis (9;75) of about 1 mm in diameter positioned off the optical axisof the eye.
 18. A sealing device according to any one of the claims1-17, being adapted to be positioned in a rhexis (30) of more than 1 mmin diameter positioned to include the optical axis of the eye.
 19. Asealing device according to any one of the preceding claims, beingadapted to remain in the capsular bag (28;75) after the intraocularlens-forming process is completed.
 20. A sealing device according toclaim 18 or 19, wherein said plug part (32;43) being optically clear.21. A sealing device according to claim 18, wherein said plug part(32;43) covers the whole path of light that is admitted by the pupil.22. A sealing device according to claim 21, being designed to compensatefor aberration.
 23. A sealing device according to any one of the claims21 or 22, being designed to correct for error of refraction in the eye.24. A sealing device according to any one of the claims 1-23, beingadapted to be removed after the intraocular lens-forming process iscompleted.
 25. A method of obtaining visual correction subsequent tosurgically removing the natural lens characterized by the steps of:inserting a plug part (23;43;63;77) of a sealing device (21;41;61;71)through a capsulorhexis (30;75), said plug part (23;43;63;77) beingadapted to cover the capsulorhexis (30;75) from the inside of thecapsular bag (28;73); adjusting said the location of said plug part(23;43;63;77) with an adjusting means (25;45;65) operable from theoutside of the capsular bag (28;73); delivering a lens-forming materialthrough the capsulorhexis (30;75) into the capsular bag (28;73) by usinga delivering means and by displacing and/or deforming the plug part(23;43;63;77) to admit passage for the material; removing the deliveringmeans out from the eye, whereby the plug part (23;43;63;77) retainssealing position (30;75), thereby preventing displacement of thelens-forming liquid material out from the capsular bag (28;73).
 26. Amethod according to claim 25, further comprising the step of removingthe sealing device (21;41;61;71) through the capsulorhexis (30;75) whenthe lens forming process is completed.
 27. A method according to claim25, comprising the step of removing the adjusting means (45;65) when theplug part seals the capsulorhexis (30;75) by the influence of thelens-forming material in the capsular bag (7;28;73).
 28. A methodaccording to any one of the claims 25 to 27, comprising the step ofcontrolling the position of said plug part (23;43;63;77) by means of theadjusting means (25;45;65).
 29. A method according to any one of theclaims 25 to 28, comprising the step of delivering the lens-formingmaterial to the capsular bag (28) through a cut (49) in the plug part(43) and through the capsulorhexis (30).
 30. A method according to anyone of the claims 25 to 29, further comprising measuring the error ofrefraction of the eye and optionally selecting a sealing device having aplug part capable of least partially to compensate for an error ofrefraction.
 31. A method according to any one of the claims 25 to 30,further comprising measuring the corneal topography of the cornea andthereby the amount aberrations of a wavefront arriving from the corneaand selecting a sealing device having plug part with at least onesurface that is capable compensate for at least one such aberration. 32.A method according to any of claims 25 to 31, including estimating atleast one aberration of the lens to be formed in the capsular bag andselecting a sealing device having plug part together with said implantedlens can compensate for at least on such aberration.
 33. A methodaccording to claim 25, comprising introducing an agent capable ofcounteracting the formation of a secondary cataract by epithelial cellgrowth on the capsular bag inner wall, before delivering the lensforming material.
 34. A method of performing visual correction in apatient by replacing the natural lens with a lens implant comprising: a)excising an area of the anterior capsular bag of the eye having asufficient size to surgically remove the natural lens; b) locating asealing device comprising a flexible plug part and removable adjustingmeans of a size sufficient to cover said excised area with saidadjusting means to a position where a peripheral anterior surface ofsaid plug part contacts the inner (posterior) wall so as to sufficientlycover said excised area; c) delivering a lens filling material into thecapsular a bag by using a delivering means to temporarily displaceand/or deform said plug part to admit passage into the capsular bag ofsaid material; d) before removing the delivery means, introducing lensforming material into the capsular bag to an extent that said materialexerts a sufficient pressure on the posterior side of the plug part toseal the excised area, so said lens material is prevented from beingdisplaced from the capsular bag to the posterior chamber of the eye; ande) finalizing the lens forming process in the eye.
 35. A methodaccording to claim 34, wherein said excised area is intersected by theoptical axis.
 36. A method according to claim 35, wherein said excisedarea has a largest diameter that essentially extends over the visualfiled.
 37. A method according to claim 34, comprising removing theadjustment means of the sealing device from the eye after completing theintroduction of lens forming material into the capsular bag.
 38. Amethod according to claim 34, comprising removing the adjustment meansof the sealing device from the eye upon finalizing the lens formingprocess.
 39. A method according to claim 34, comprising introducing anagent capable of counteracting the formation of a secondary cataract byepithelial cell growth on the capsular bag inner wall, beforeintroducing the lens forming material.
 40. A method according to claim34, comprising the step introducing the lens-forming material to thecapsular bag through a cut in the plug part.
 41. A method according toclaim 34, comprising measuring the corneal topography of the cornea andthereby the amount aberrations of a wavefront arriving from the corneaand selecting a sealing device having a plug part with at least onesurface that is capable compensate for at least one such aberration. 42.A method according to any of claim 41, including estimating at least oneaberration of the lens to be formed in the capsular bag and selecting asealing device having plug part together with said implanted lens cancompensate for at least on such aberration.
 43. A method according toclaim 34, comprising introducing an agent capable of counteracting theformation of a secondary cataract by epithelial cell growth on thecapsular bag inner wall, before delivering the lens forming material